P&S-F-03-10

Date:01/08/2017 Rev No. 0

CONFLICT OF INTEREST - DISCLOS URE FORM
FOR VENDOR Page 1 of 1

Vendor Name: _____________________________________ NTN No.: _________________

Registration Number (in case of a registered Company) _____________________

Vendor Code (if registered in PSO): _____________________ Date: ____________________

S.No. Conflict of Interest Situation Yes No
Whether you or any of your
spouse/parents/children/relatives/business
1- partners/directors/employees are currently under PSO’s
employment as management/non-management or outsourced
contractor’s staff.
If yes, please provide details:

_______________________________________________________________________

_______________________________________________________________________

Whether any of your business partners/directors/senior

management has any immediate family member/relatives
2-
working with PSO as management/non-management or
outsourced contractor’s staff.
If yes, please provide details:

_______________________________________________________________________

______________________________________________________________________

3- Any other situation of conflict of interest.

Please provide details:

_______________________________________________________________________

______________________________________________________________________

Please tick the relevant box and provide complete details:

Note: The above informations are required to avoid any potential conflict of interest situation which, may
effect transperancy and fairness of the business between PSO and any vendor. However, presence of a
conflict of interest situation does not necessarily mean that both parties can not do business at all. It
depends upon the nature of the situation.

We, M/S ___________________________________ hereby accept full responsibility and strict liability for
making any false Declaration, not making full disclosure, misrepresenting facts or taking any action likely to
defeat the purpose of this declaration and accordingly Pakistan State Oil Company Limited has every right
to take any disciplinary action against us in accordance with PSO’s policy and relevant laws.

We also assure that any change in the above status shall be promptly informed by us to the PSO concerned
officials

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 P&S-F-03-10
Date:01/08/2017 Rev No. 0
CONFLICT OF INTEREST - DISCLOS URE FORM
FOR VENDOR Page 2 of 1

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Vendor’s representative (Name, Designation, Signature alongwith Company’s stamp)

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